| Psychotherapy 45 minutes CPT 90834 • Mental Health | $93 | $158 | $224 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $69 | $144 | $218 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $103 | $219 | $335 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $108 | $185 | $262 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $131 | $224 | $317 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $64 | $116 | $167 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $76 | $161 | $246 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $93 | $174 | $255 |
| Group psychotherapy CPT 90853 • Mental Health | $63 | $65 | $67 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $11 | $11 | $11 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $333 | $370 | $407 |
| Chemodenervation of muscle cervical dystonia CPT 64612 • Neurology | $17 | $169 | $320 |
| Chemodenervation of muscle neck CPT 64616 • Neurology | $128 | $195 | $262 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $139 | $221 | $304 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $140 | $278 | $417 |
| Electromyography (EMG) 1 extremity CPT 95860 • Neurology | $104 | $164 | $281 |
| Electromyography (EMG) 2 extremities CPT 95861 • Neurology | $146 | $164 | $200 |
| EMG needle each extremity complete CPT 95886 • Neurology | $49 | $83 | $117 |
| Nerve conduction study 1-2 nerves CPT 95907 • Neurology | $87 | $109 | $130 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $105 | $166 | $286 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $342 | $342 | $342 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $171 | $180 | $190 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $260 | $270 | $280 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $160 | $163 | $165 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $162 | $209 | $255 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $141 | $210 | $348 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $187 | $377 | $505 |
| Office visit established patient minimal CPT 99211 • Office Visits | $20 | $36 | $52 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $95 | $112 | $128 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $110 | $158 | $207 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $108 | $129 | $170 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $310 | $361 | $412 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $218 | $223 | $228 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $295 | $301 | $307 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $148 | $344 | $451 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $84 | $86 | $88 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $155 | $159 | $162 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $224 | $228 | $233 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $156 | $160 | $163 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $97 | $188 | $238 |
| Consultation office low complexity CPT 99243 • Office Visits | $63 | $144 | $263 |
| Consultation office high complexity CPT 99245 • Office Visits | $20 | $333 | $499 |
| Blepharoplasty upper eyelid CPT 15823 • Ophthalmology | $548 | $1,011 | $1,474 |
| Foreign body removal external eye corneal CPT 65210 • Ophthalmology | $39 | $75 | $111 |
| Corneal transplant endothelial CPT 65756 • Ophthalmology | $2,848 | $2,848 | $2,848 |
| Trabeculoplasty laser surgery CPT 65855 • Ophthalmology | $500 | $500 | $500 |
| Trabeculectomy glaucoma filtering surgery CPT 66170 • Ophthalmology | $1,112 | $1,869 | $2,627 |
| Endoscopic cyclophotocoagulation CPT 66711 • Ophthalmology | $511 | $744 | $1,204 |
| Iridotomy laser surgery CPT 66761 • Ophthalmology | $567 | $567 | $567 |
| Cataract surgery complex with intraocular lens CPT 66982 • Ophthalmology | $1,803 | $1,803 | $1,803 |